Breathless patients are a challenge in the ED. Shortness of breath can be a frightening presenting complaint for both patients and doctors. As always, think about the possible life threatening causes and actively rule them out. For breathless patients think especially about:
Breathless Patients Podcast
In this podcast Iain and Simon discuss their approach to breathless patients in the ED which we hope will provide you with a good starting point.
For those of you who are more visual learners here is the video recorded a few years ago for SEMEP featuring our very own Iain Beardsell.
http://vimeo.com/35310564
Take Home Points
Oxygen - or no oxygen??
Oxygen administration is rarely a problem in the immediate and acute
setting - and can save lives. So yes, when you first approach a patient
who is short of breath, get that oxygen on while you make your
assessment then think about the finer points of respiratory failure
afterwards.
Where do I begin?
A focused history, including asking the patient about previous conditions and whether they know what's going on!
And then - initial assessment and examination including vital signs
(especially respiratory rate), looking for clues as to the underlying
cause of their breathlessness, remembering the five common causes.
What treatments might be useful?
A small fluid bolus might help and carries relatively little risk;
think about the need for nebulised bronchodilators for patients with
asthma or COPD, and remember that antibiotics given early to patients
with sepsis save lives.
If the patient has pain we should definitely treat that too.
Which investigations might help me find out more?
One of the key investigations in patients with shortness of breath is the humble chest radiograph. There are some phenomenal FOAM resources for interpretation of CXRs (along with other XRs) at Radiology Masterclass. Well worth bookmarking for your ED shifts (but do ask a senior if you're unsure).
Chest X-Ray Anatomy - Chest X-Ray Abnormalities - Chest X-Ray Systematic Approach
Think! Do you really need an ABG? If the answer is yes, please use local anaesthetic! Your patients will thank you...
Further Reading on Shortness of BreathThe Flipped EM Classroom - Shortness of Breath (with further links).
Natalie May
Ep 130 - Critical Appraisal Nuggets: p-values
Ep 129 - January 2019 Round Up
Ep 128 - Can we use diagnostic probability to guide treatment thresholds in ACS with Charlie Reynard and Rick Body
Ep 127 - The Journey that Matters with Clare Richmond at #stemlynsLIVE
Ep 126 - December 2018 Round Up
Ep 125 - November 2018 Round Up
Ep 124 - Human factors, technology and humanity in critical care with Peter Brindley
Ep 123 - Five strategies to improve your resuscitations with Simon Carley at #stemlynsLIVE
Ep 122 - Beyond ALS with Salim Rezaie at #stemlynsLIVE
Ep 121 - October 2018 Round Up
Ep 120 - The pursuit of excellence with Nat May at #stemlynsLIVE
Ep 119 - September 2018 Round Up
Ep 118 - August 2018 Round Up
Ep 117 - EMS Gathering 2018 with Aiden Baron
Ep 116 - Moral Injury in emergency and prehospital care with Esther Murray
Ep 115 - July 2018 Round Up
Ep 114 - The past, present and future of IV Fluids in Paediatric Practice with Steve Playfor
Ep 113 - The best of badEMfest 2018
Ep 112 - Acute Psychiatric Emergencies in the ED.
Ep 111 - April 2018 Round Up
Create your
podcast in
minutes
It is Free
The Relaxback UK Show
Good Nurse Bad Nurse
On Call With Dr. Anselm Anyoha
The Doctor’s Farmacy with Mark Hyman, M.D.
The Peter Attia Drive